Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts.
OBJECTIVE
Standard therapy of mycotic aneurysms in the descending aorta consists of thoracotomy and in situ graft placement or extraanatomic bypass. The alternative use of endovascular stent-grafts was evaluated for management of infected aneurysms of the thoracic aorta.


METHODS
In a retrospective analysis during a 5-year period, 112 patients underwent stent-graft placement for thoracic aortic aneurysms. Three patients (mean age, 68.6; range, 64-70 years) had mycotic thoracic aneurysms. Stent-grafts were constructed from Z stents covered with polyester fabric and were delivered remotely through a catheter under fluoroscopic guidance.


RESULTS
Complete thrombosis of the mycotic aneurysms was achieved in all patients. One patient required a second separate stent-graft placement procedure because of migration of the initial device; the second patient underwent surgical repair of a ruptured mycotic abdominal aortic aneurysm followed immediately by stent-graft placement for a chronic mycotic thoracic aneurysm; a third patient underwent repair of two infected false aneurysms secondary to complete rupture of a surgical interposition graft. There were no complications of persistent bacteremia despite placement of the stent-graft device at the site of primary infection, reinfection, delayed rupture, paraplegia, distal emboli, or surgical conversion. One patient died of cardiac arrest at 25 months; there were no perioperative deaths (< or = 30 days). The remaining two patients were alive and well at median follow-up of 24 months (range, 4-25 months).


CONCLUSIONS
Endovascular stent-grafts combined with antibiotic therapy may be an alternative to conventional thoracotomy in managing mycotic aneurysms of the descending thoracic aorta.
Semba
C P
CP
Division of Cardiovascular-Interventional Radiology, Stanford University Medical Center, CA 94305-5115, USA.
Sakai
T
T
Slonim
S M
SM
Razavi
M K
MK
Kee
S T
ST
Jorgensen
M J
MJ
Hagberg
R C
RC
Lee
G K
GK
Mitchell
R S
RS
Miller
D C
DC
Dake
M D
MD
D000368:Aged; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents